Provider Demographics
NPI:1346562378
Name:WHITMAN, BRENT M
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:M
Last Name:WHITMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6025 NY STATE ROUTE 5
Mailing Address - Street 2:
Mailing Address - City:PALATINE BRIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:13428
Mailing Address - Country:US
Mailing Address - Phone:518-673-2366
Mailing Address - Fax:518-673-2387
Practice Address - Street 1:6025 NY STATE ROUTE 5
Practice Address - Street 2:
Practice Address - City:PALATINE BRIDGE
Practice Address - State:NY
Practice Address - Zip Code:13428
Practice Address - Country:US
Practice Address - Phone:518-673-2366
Practice Address - Fax:518-673-2387
Is Sole Proprietor?:No
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049932183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist